Intended for healthcare professionals

Rapid response to:

Practice The Competent Novice

How to handle stress and look after your mental health

BMJ 2009; 338 doi: https://doi.org/10.1136/bmj.b1368 (Published 27 April 2009) Cite this as: BMJ 2009;338:b1368

Rapid Response:

The NHS is the elephant in the corner

Iverson and colleagues have written an excellent article
which looks at practical steps within the sphere of
influence of the individual. They focus on biological
symptoms and psychological aspects as well as offering
specific comment about the effects of 'stress'on areas of
fitness to practice. They have covered the Bio-Psycho
aspects of the BioPsychoSocial model. The elephant in the
corner is the context within which stress occurs: the NHS.

The NHS as it has developed has become a psychological
toxin. Agendas are set centrally and doctors have become
detached from the leadership of the organisation. Doctors
feel out of control within an organisation which is
focussed on short-term matters to quieten the public and
the media. The purpose of the NHS appears to have become as
confused as anything else the government touches. Indeed
the behaviour of NHS 'leaders' and their political organ-
grinders has more than a little in common with the short-
termism so roundly denounced among financial institutions.

Christina Maslach (author of the standard research tool in
the area: the Maslach Burnout Inventory) identifies burnout
as being a product of a mismatch between expectations and
reality in 6 areas: Demands, Control, Reward, Community,
Fairness and Values. These characteristics broadly
correspond to the characteristics of stress described by
the Health and Safety Executive.

These present the contextual factors that make up the
'Social' part of BioPsychoSocial. Until the contextual
factors are addressed doctors who adapt may only store up
trouble for later. Professor Chris McManus put it well
‘cynicism should also be recognised as adaptive, whereas
professional efficacy can be maladaptive, increasing future
stress and burnout’ Lancet 2002.

The single best way to deal with stress among doctors is to
develop a clear purpose for the NHS based on honest
principles providing the best deal for the greatest number.
The organisation must be divorced from political
interference and avoid neck-jerk reaction to bad practice.
An atmosphere of trust, respect and responsibility then
stands a chance of taking root. Doctors are more likely to
thrive in an environment where they feel that much or all
of what they do serves a clear individual and collective
purpose. At present too many are struggling by until they
limp over the finishing line.

Competing interests:
None declared

Competing interests: No competing interests

14 May 2009
John Sharkey
Consultant Psychiatrist in Occupational Health
Independent sector, Northern Ireland